In 2018, Reproaction expanded our campaign into Arkansas to highlight the reality of Black maternal and infant mortality. Through this campaign, I sat down with mothers, doulas and midwives, community organizers, public health officials, clinicians, and other passionate Arkansans to learn about their experiences and perception of maternal health in the state. To delve deeper, we hosted documentary screenings, panel discussions, and informational tables to better understand what’s driving the state’s high maternal and infant deaths.

It became abundantly clear that asking questions about pregnancy health in Arkansas was long overdue. We know statistics: Arkansas has the third highest maternal mortality rate in the United States. Black women are up to three to four times more likely to die from pregnancy-related complications than their white counterparts, even when accounting for income and education.

Racial bias in medical care is well-established, and bias does not have to be explicit to be harmful. Snap judgement calls made during the course of medical care can tap into the implicit bias of medical professionals and lead to missing serious issues. Overlooking concerns by Black mothers and pregnant women creates emergency situations — even for financially powerful women like Serena Williams. Despite knowing her medical history of blood clots and symptoms, Williams was initially dismissed when she specifically requested treatment after childbirth. Her persistence in spite of her dismissal may have saved her life, because. Her experience is not unique. Studies have shown that physicians systematically undertreat Black patients for pain in relation to white patients with the same health problems. In a state like Arkansas which is increasingly attempting to make forced childbirth the law of the land by slashing low-cost contraception access and making abortion illegal, the reality of racial bias in pregnancy care has chilling implications.

During community outreach events, I recognized an infuriatingly common refrain: Pregnant people simply weren’t being listened to during critical moments in their lives. When experiencing pain, describing a symptom, asking for more information, or bringing up a concern about their care, almost all described being doubted or ignored at some point. For Black women, that disregard can be deadly.

Many women in Arkansas experience traumatic births, low-quality care, and preventable issues during pregnancy. Their testimony guided the Storytelling for Justice project I led, conceived as a medium to illuminate the people behind the statistics. By recording accounts from Black mothers in Arkansas, I hoped to provide a space to describe their experiences in their own words and to raise public awareness to make changes in maternal health outcomes in Arkansas. This change will not come from advisory councils exclusively populated by clinicians and researchers. Improvements in pregnancy-related health must include those not being cared for adequately by our medical system. Essentially: if you want to understand what’s going wrong with pregnancy in Arkansas, listen to Black women.

Nicolle, Certified Doula, Educator, Mother

I have attended a lot of births in Arkansas over the past nine years. For the first seven years, my clientele was mostly Caucasian, and I had a very positive perception of pregnancy in Arkansas. I had good rapport, my clients were treated well, their voices listened to and validated. In the past two years, I had a sudden uptick in African American clients, and it was like day and night. I was shocked.

During my first hospital delivery with an African American woman, it was blatantly clear that her voice was not heard in the same way. I experienced a doctor refusing to come visit his patient during concerns despite the fact that he was in the building. I often teach that there is pain associated with childbirth, but there should not be suffering. And my client experienced suffering. It was torturous; she was not provided pain medication for five hours. She was ignored. I had never seen this treatment with a Caucasian client. My African American clients were experiencing issues my Caucasian clients were not.

Another African American client was being induced with Pitocin (a medication that causes contractions), but the Pitocin was increasing the baby’s heart rate in a concerning way. The doctor ordered the Pitocin be turned off to make sure his heart stabilized. The nurse came back in several times over the night and increased the Pitocin to ‘speed things up.’ When we asked about it, the nurse said, “Remember, we talked about this,” despite the fact that no one had discussed anything with her, and it was a danger to her baby. They were willing to sacrifice safety for efficiency, and she received no apology.

This didn’t just happen to my clients. When I was giving birth before I was a doula, I went to the hospital in labor. I told the hospital staff I was actively in labor and my contractions were close, and I was dismissed. I was left in triage until I yelled, “The baby’s coming!” I gave birth in triage. Afterwards they joked, “I guess you were right, we should probably pull your charts.” The first rule of medicine is ‘do no harm.’ Not listening is doing harm.

The Arkansas statistics are painful, but it’s a pain consistent with the life of an African American woman. It’s shocking, but it’s not. Many people know the statistics. Care providers know them, and many in the community may be aware. But there’s not enough action taking place. There’s no reason that that should be a statistic. ‘Maybe it’s socioeconomic, maybe it’s all those poor Black negroes out there.’ No, that’s not what it is. The message that I received was that my life and my children’s lives are not valuable enough to institute changes. And those are the words no one wants to say. That’s the truth.

Shakia, Public Health Professional, Mother

My first pregnancy is so sad to think about because it was so bad. I thought that because I had private insurance, I would be treated well. I had heard that Black women on public insurance should just expect to be treated worse. I was 42 weeks pregnant and in labor for three days with little change, going back and forth to the hospital. When I was hooked up to a monitor, I watched his [the baby’s] heart rate drop. I was brushed off like I didn’t know what I was talking about. I had been staring at the monitor for hours! I saw the change. I was so tired and weak, I hadn’t eaten in days. The same thing happened again, and suddenly I was rushed into the operating room for an emergency C-section. They gave me no time to think, even though I had brought this up earlier! It was suddenly an emergency to them.

Later, I wanted to breastfeed. I was told I couldn’t because I had an infection, but they didn’t say what kind [of infection] and it was never in my records. That nurse also remarked, “You’re not gonna breastfeed anyway.” Why would she say that? The nicest thing that happened to me was a Black nurse brought me a sandwich later. She was the only person I felt listened to my needs.

Pregnancy is already scary, and I know medical providers can be stretched thin. But if my physician had taken the time to look into my labor being in distress, I could have avoided these problems. I later found out that same physician had a patient die during labor. And I kept thinking how it could have been me.

During another pregnancy, I had debilitating migraines and went to the doctor for help. I felt like my doctor thought I was trying to get out of work. She told me, “Pregnancy isn’t a disability.” I was high-risk, I was in pain, why would it hurt to put me on bed rest?

Black women and babies are dying in Arkansas and it needs to be taken as seriously as other health issues.

Shauna, Breastfeeding Educator, Mother

I am somewhat new to the world of pregnancy health, but after problems with my last pregnancy I went into this work.  I was a Medicaid patient, and the care was not what it should have been.  During one of my appointments I mentioned a mysterious bite on my leg that the doctor could not identify, which struck me as odd. After the doctor made a few phone calls to other doctors, I was still not informed of what kind of bite it was; I was just given a tetanus shot and sent home.  Around 34 weeks into my pregnancy, I went in for a regular visit to be told my blood pressure was elevated and sent to be observed at the hospital. And that is when my horrible birth experience began. After three days of being overmedicated with Demerol, Pitocin, magnesium sulfate, morphine, and an epidural, and only being able to hear my baby’s heartbeat, I was informed by a different doctor that I had ‘a couple of seconds to decide’ but my baby had to come out NOW!  At no point did I make any decisions for myself.  No explanation was given.  Later, I was informed that I had too much medication in my system, but instead of taking me off the medication to see if my baby’s vitals improved so I could have another vaginal birth (like I did with my previous children), they did an emergency C-section.

Knowing what is happening in Arkansas makes me feel horrible. Why are we not trying to fix this? Public versus private insurance has a role in medical care, but there’s more to it. They don’t listen to us. They talk to us like we don’t know what we’re talking about. And there’s a stigma against us when we try to advocate for ourselves— then we are labeled as angry Black women.  Something has to change.

Stacey*, Mother

I was pregnant with twins and began having stomach pains five months along. There was a smell coming from my vagina, too. I lived way out of town in South Arkansas. I went to the closest hospital 30 minutes away, told the doctors I was pregnant with twins, and was checked. They told me they checked and said they couldn’t find anything wrong. I heard the heart monitor and said I could only hear two heartbeats, but there should be three. I was told I was wrong, they just got mixed up on the monitor. I knew that wasn’t right because I heard them during another ultrasound I had awhile back. I asked about the smell, and they acted like it was me not being clean. I knew it wasn’t that. They sent me home with some pain medication. I didn’t feel right, so I drove to another emergency room an hour away from that one.

One of my twins had died in the womb and it was hurting me. They told me if I wouldn’t have come it would have poisoned me. They knew what it was really quick and rushed me to emergency surgery to remove the one that died. If I didn’t trust my instinct, I could have died. I have a healthy child now, but we both might not be here. I didn’t know Black women died so much during pregnancy, but I can see why.

Yolanda*, Mother

I gave birth in prison. I was chained up during the ride to the hospital, it was uncomfortable. I was like “where do you think I’m going? I’m about to have a baby.” When I was in the hospital bed, they unchained my arms. And after I gave birth, they chained me up again. I got to spend the day with my baby, and then they took her from me and I went back to prison. That was the darkest time. I don’t like thinking about it. I just had this baby, and she was gone. I just wouldn’t wish that on anyone. I didn’t see her again for three months.

When you’re in prison, they try to get you to give up your kids. I get that some people can’t be good parents and it’s best they go with new people, but I’ve seen them not turn in paperwork for kids to go with a family member so they can have them adopted out. Just because I’m in prison doesn’t mean I’m not still a mom with rights. I’m here trying to get my life right now that I’m out, working to make a better life. They try to snatch our babies away. That’s why they call that prison employee the baby snatcher. Because that’s what she does. She steals peoples’ kids because she decided we’re not good enough.

*names changed to protect privacy